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Oftalmopatía de Graves , Humanos , Dinamarca/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Oftalmopatía de Graves/diagnóstico , Oftalmopatía de Graves/complicaciones , Oftalmopatía de Graves/fisiopatología , Oftalmopatía de Graves/epidemiología , Adulto , Anciano , Enfermedades de la Tiroides/epidemiología , Enfermedades de la Tiroides/diagnóstico , Enfermedades de la Tiroides/fisiopatología , Oftalmopatías/epidemiología , Oftalmopatías/diagnóstico , Oftalmopatías/etiología , Oftalmopatías/fisiopatologíaRESUMEN
INTRODUCTION: Obstetrics research has predominantly focused on the management and identification of factors associated with labor dystocia. Despite these efforts, clinicians currently lack the necessary tools to effectively predict a woman's risk of experiencing labor dystocia. Therefore, the objective of this study was to create a predictive model for labor dystocia. MATERIAL AND METHODS: The study population included nulliparous women with a single baby in the cephalic presentation in spontaneous labor at term. With a cohort-based registry design utilizing data from the Copenhagen Pregnancy Cohort and the Danish Medical Birth Registry, we included women who had given birth from 2014 to 2020 at Copenhagen University Hospital-Rigshospitalet, Denmark. Logistic regression analysis, augmented by a super learner algorithm, was employed to construct the prediction model with candidate predictors pre-selected based on clinical reasoning and existing evidence. These predictors included maternal age, pre-pregnancy body mass index, height, gestational age, physical activity, self-reported medical condition, WHO-5 score, and fertility treatment. Model performance was evaluated using the area under the receiver operating characteristics curve (AUC) for discriminative capacity and Brier score for model calibration. RESULTS: A total of 12,445 women involving 5,525 events of labor dystocia (44%) were included. All candidate predictors were retained in the final model, which demonstrated discriminative ability with an AUC of 62.3% (95% CI:60.7-64.0) and Brier score of 0.24. CONCLUSIONS: Our model represents an initial advancement in the prediction of labor dystocia utilizing readily available information obtainable upon admission in active labor. As a next step further model development and external testing across other populations is warranted. With time a well-performing model may be a step towards facilitating risk stratification and the development of a user-friendly online tool for clinicians.
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Índice de Masa Corporal , Distocia , Edad Materna , Paridad , Humanos , Femenino , Embarazo , Distocia/epidemiología , Adulto , Factores de Riesgo , Dinamarca/epidemiología , Curva ROC , Inicio del Trabajo de Parto , Sistema de Registros , Edad GestacionalRESUMEN
BACKGROUND AND OBJECTIVES: Idiopathic generalized epilepsy (IGE) is associated with distinct behavioral traits, symptoms of frontal lobe dysfunction, and psychiatric comorbidity. Whether psychiatric symptoms are part of the IGE endophenotype or secondary to the burden of chronic disease is unknown. In this study, we aimed at describing the sequence of appearance of psychiatric and epilepsy symptoms in patients with IGE. METHODS: Inclusion criteria for this cohort study were diagnosis of IGE with age at diagnosis at 10-25 years. We created 2 mutually exclusive cohorts, 1 based on ICD-10 codes in Danish registers with a first IGE diagnosis from January 1, 2005, to December 31, 2018, and a second patient cohort treated at Odense University Hospital and the Danish Epilepsy Centre in the same period. Each case was matched with 10 age-matched, sex-matched, and geography-matched normal population controls from the Danish registers. We compared social status, health care utilization, and psychiatric diagnoses between the groups in the 5 years preceding epilepsy diagnosis, at diagnosis, and at the end of the study period using the Wilcoxon rank-sum test and confirmatory logistic regression models. RESULTS: We identified 1,009 patients for the register-based cohort (55.1% female; mean age at diagnosis [SD]: 15.9 [±3.8] years) and 402 patients for the hospital-based cohort (56.2% female; mean age at diagnosis [SD]: 18.3 [±7.4] years) and matched them to 10,090 and 4,020 controls, respectively. IGE cohorts and controls did not differ at birth. In the 5 years before their IGE diagnosis, register patients had an increasing number of contacts with hospitals (mean visits [SD]: cases: 8.3 [±5.6], controls: 6.6 [±4.5]) and their general practitioners (mean visits [SD]: cases: 48.7 [±26.3], controls: 45.3 [±24.5]) and received more prescriptions for psychiatric medications (prescriptions: cases: 4.2%, controls: 2.5%, p = 0.003) compared with controls. Patients had a higher rate of psychiatric comorbidity (comorbidity: cases: 26.5%, controls: 17.8%, p < 0.0001) at the end of the study than controls. Data were similar in the hospital-based cohort. DISCUSSION: Our data suggest a prodromal phase of IGE detectable approximately 5 years before the first seizure characterized by increased health care utilization and greater use of prescription medicine for psychiatric symptoms.
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Epilepsia Generalizada , Síntomas Prodrómicos , Sistema de Registros , Humanos , Femenino , Epilepsia Generalizada/epidemiología , Masculino , Estudios de Casos y Controles , Adolescente , Adulto , Adulto Joven , Dinamarca/epidemiología , Niño , Estudios de Cohortes , Trastornos Mentales/epidemiologíaRESUMEN
BACKGROUND AND PURPOSE: Prosthetic joint infection (PJI) following total hip arthroplasty (THA) has a severe impact on patients. We investigated the risk of second revision and mortality following first-time revision due to PJI. METHODS: We identified 1,669 first-time revisions including 416 treated with debridement, antibiotics, and implant retention (DAIR) from the Danish Hip Arthroplasty Register (DHR). First-time revision due to PJI was defined as a revision with ≥ 2 culture-positive biopsies for the same bacteria or re-ported as PJI to the DHR within 1 year after primary THA with non-PJI revisions as controls. We retrieved information on Charlson Comorbidity Index (CCI), death, cohabitation status, and cultures from intraoperative biopsies. The adjusted relative risk (RR) with 95% confidence interval (CI) was calculated by first-time revision (PJI or non-PJI). Patients were followed from first-time revision until end of study. RESULTS: PJI was found in 140 of 280 patients having a second revision following any first-time revision. Of these 280 patients, 200 were treated with DAIR as second revision. Patients with first-time revision due to PJI had an increased risk of second revision compared with first-time revision for non-PJI with an adjusted RR for second revision due to any cause of 2.7 (CI 1.9-3.8) and second revision due to PJI of 6.3 (CI 4.0-10). The 10-year adjusted RR for mortality for patients with first-time revision due to PJI compared with non-PJI was 1.8 (CI 0.7-4.5). CONCLUSION: The risk of second revision was increased both for second revision due to any reason and due to PJI following first-time revision due to PJI. Mortality risk following first-time revision due to PJI was increased, but not statistically significant.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Infecciones Relacionadas con Prótesis , Sistema de Registros , Reoperación , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/mortalidad , Reoperación/estadística & datos numéricos , Infecciones Relacionadas con Prótesis/mortalidad , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/cirugía , Masculino , Femenino , Dinamarca/epidemiología , Anciano , Persona de Mediana Edad , Prótesis de Cadera/efectos adversos , Factores de Riesgo , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Desbridamiento , AdultoRESUMEN
PURPOSE: To investigate the early implementation of combined systematic and targeted (cBx) primary biopsy in prostate cancer diagnosis and define the concordance in Gleason grading (GG) of different biopsy techniques with radical prostatectomy (RP) pathology. METHODS: This population-based analysis includes data on all men in Denmark who underwent primary cBx or standalone systematic (sBx) prostate biopsy between 2012 and 2016. Biopsy results were compared to RP pathology if performed within a year. Concordance measurement was estimated using Cohen's Kappa, and the cumulative incidence of cancer-specific death was estimated at 6 years with the Aalen-Johansen estimator. RESULTS: Concordance between biopsy and RP pathology was 0.53 (95CI: 0.43-0.63), 0.38 (95CI: 0.29-0.48), and 0.16 (95CI: 0.11-0.21) for cBx, targeted biopsy (tBx), and sBx, respectively. For standalone sBx and RP, concordance was 0.29 (95CI: 0.27-0.32). Interrelated GG concordance between tBx and sBx was 0.67 (95CI: 0.62-0.71) in cBx. The proportion of correctly assessed GG based on RP pathology was 54% in both cBx and standalone sBx. Incidence of prostate cancer-specific death was 0% regardless of biopsy technique in GG 1, and 22% (95CI: 11-32), 30% (95CI: 15-44), and 19% (95CI: 7.0-30) in GG 5 for cBx, tBx, or sBx, respectively. CONCLUSION: Overall, the cBx strategy demonstrates higher concordance to RP pathology than the standalone sBx. However, cBx exhibits more overgrading of the GG of RP pathology compared to sBx. Ultimately, the classic grading system does not take change in the diagnostic pathway into account, and grading should be altered accordingly to ensure appropriate treatment.
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Clasificación del Tumor , Neoplasias de la Próstata , Humanos , Masculino , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Dinamarca/epidemiología , Persona de Mediana Edad , Anciano , Prostatectomía/métodos , Biopsia , Factores de Tiempo , Próstata/patologíaRESUMEN
BACKGROUND: Fishers are at risk of back disorders due to their physically demanding work. The aim was to investigate risk factors for back disorders in fishers in Denmark. METHODS: All male Danish registered fishers between 1994 and 2017 were included. ICD-10 codes classified back disorders (M40-M54* and DM99.1-4*). A multistate model on a cause-specific cox regression model was conducted. RESULTS: Of 13,165 fishers included, 16% had a hospital contact with an incident back disorder, and 52% at least had 1 recurrent episode. Having worked in another occupation (HR 1.14; 95% CI: 1.02, 1.27) and another musculoskeletal disorder (HR 1.84; 95% CI: 1.69, 2.01) were significant risk factors for the incident back disorder. No risk factors were seen for recurrent episodes. CONCLUSIONS: Risk factors for incident and recurrent back disorders were different; thus, episode-specific initiatives are needed to reduce back disorders among fishers.
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Enfermedades Profesionales , Recurrencia , Sistema de Registros , Humanos , Dinamarca/epidemiología , Masculino , Factores de Riesgo , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/etiología , Adulto , Persona de Mediana Edad , Incidencia , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Musculoesqueléticas/etiología , Adulto Joven , Modelos de Riesgos ProporcionalesRESUMEN
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma can be treated with inhaled corticosteroids (ICS) delivered by low climate impact inhalers (dry powder inhalers) or high climate impact inhalers (pressurized metered-dose inhalers containing potent greenhouse gasses). ICS delivered with greenhouse gasses is prescribed ubiquitously and frequent despite limited evidence of superior effect. Our aim was to examine the beneficial and harmful events of ICS delivered by low and high climate impact inhalers in patients with asthma and COPD. METHODS: Nationwide retrospective cohort study of Danish outpatients with asthma and COPD treated with ICS delivered by low and high climate impact inhalers. Patients were propensity score matched by the following variables; age, gender, tobacco exposure, exacerbations, dyspnoea, body mass index, pulmonary function, ICS dose and entry year. The primary outcome was a composite of hospitalisation with exacerbations and all-cause mortality analysed by Cox proportional hazards regression. RESULTS: Of the 10,947 patients with asthma and COPD who collected ICS by low or high climate impact inhalers, 2,535 + 2,535 patients were propensity score matched to form the population for the primary analysis. We found no association between high climate impact inhalers and risk of exacerbations requiring hospitalization and all-cause mortality (HR 1.02, CI 0.92-1.12, p = 0.77), nor on pneumonia, exacerbations requiring hospitalization, all-cause mortality, or all-cause admissions. Delivery with high climate impact inhalers was associated with a slightly increased risk of exacerbations not requiring hospitalization (HR 1.10, CI 1.01-1.21, p = 0.03). Even with low lung function there was no sign of a superior effect of high climate impact inhalers. CONCLUSION: Low climate impact inhalers were not inferior to high climate impact inhalers for any risk analysed in patients with asthma and COPD.
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Asma , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Asma/tratamiento farmacológico , Asma/epidemiología , Asma/diagnóstico , Anciano , Estudios Retrospectivos , Dinamarca/epidemiología , Estudios de Cohortes , Administración por Inhalación , Adulto , Inhaladores de Polvo Seco , Clima , Inhaladores de Dosis Medida , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Helicobacter pylori colonizes the human stomach and may affect the inflammatory response, hormone production related to energy regulation, and gastrointestinal microbiota composition. Previous studies have explored a potential association between H. pylori infection and pediatric obesity with varying results. Considering the immunomodulatory effects of early-life infection with H. pylori that can confer beneficial effects, we hypothesized that we would find an inverse relationship between H. pylori seropositivity and obesity among Danish children and adolescents. METHODS: We assessed H. pylori seroprevalence in 713 subjects from an obesity clinic cohort and 990 subjects from a population-based cohort, aged 6 to 19 years, and examined its association with obesity and other cardiometabolic risk factors. RESULTS: No association was found between H. pylori and body mass index standard deviation score (BMI SDS). H. pylori seropositivity was, however, significantly associated with higher fasting plasma glucose levels and the prevalence of hyperglycemia. CONCLUSION: While we did not find an association between H. pylori seropositivity and BMI SDS, we observed a significant association with higher fasting plasma glucose levels and increased prevalence of hyperglycemia, suggesting that H. pylori infection may contribute to impaired glucose regulation in Danish children and adolescents.
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Infecciones por Helicobacter , Helicobacter pylori , Hiperglucemia , Humanos , Adolescente , Niño , Dinamarca/epidemiología , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/sangre , Masculino , Femenino , Hiperglucemia/epidemiología , Hiperglucemia/sangre , Estudios Seroepidemiológicos , Adulto Joven , Obesidad Infantil/epidemiología , Obesidad Infantil/sangre , Obesidad Infantil/microbiología , Estudios de Cohortes , Índice de Masa Corporal , Prevalencia , Glucemia/análisisAsunto(s)
Antifúngicos , Aspergillus fumigatus , Azoles , Farmacorresistencia Fúngica , Aspergillus fumigatus/efectos de los fármacos , Aspergillus fumigatus/aislamiento & purificación , Humanos , Dinamarca/epidemiología , Azoles/farmacología , Azoles/uso terapéutico , Antifúngicos/uso terapéutico , Antifúngicos/farmacología , Aspergilosis/microbiología , Aspergilosis/epidemiología , Aspergilosis/tratamiento farmacológicoRESUMEN
OBJECTIVE: To investigate associations between long term residential exposure to road traffic noise and particulate matter with a diameter <2.5 µm (PM2.5) and infertility in men and women. DESIGN: Nationwide prospective cohort study. SETTING: Denmark. PARTICIPANTS: 526 056 men and 377 850 women aged 30-45 years, with fewer than two children, cohabiting or married, and residing in Denmark between 2000 and 2017. MAIN OUTCOME MEASURE: Incident infertility in men and women during follow-up in the Danish National Patient Register. RESULTS: Infertility was diagnosed in 16 172 men and 22 672 women during a mean follow-up of 4.3 years and 4.2 years, respectively. Mean exposure to PM2.5 over five years was strongly associated with risk of infertility in men, with hazard ratios of 1.24 (95% confidence interval 1.18 to 1.30) among men aged 30-36.9 years and 1.24 (1.15 to 1.33) among men aged 37-45 years for each interquartile (2.9 µg/m3) higher PM2.5 after adjustment for sociodemographic variables and road traffic noise. PM2.5 was not associated with infertility in women. Road traffic noise (Lden, most exposed facade of residence) was associated with a higher risk of infertility among women aged 35-45 years, with a hazard ratio of 1.14 (1.10 to 1.18) for each interquartile (10.2 dB) higher five year mean exposure. Noise was not associated with infertility among younger women (30-34.9 years). In men, road traffic noise was associated with higher risk of infertility in the 37-45 age group (1.06, 1.02 to 1.11), but not among those aged 30-36.9 years (0.93, 0.91 to 0.96). CONCLUSIONS: PM2.5 was associated with a higher risk of an infertility diagnosis in men, whereas road traffic noise was associated with a higher risk of an infertility diagnosis in women older than 35 years, and potentially in men older than 37 years. If these results are confirmed in future studies, higher fertility could be added to the list of health benefits from regulating noise and air pollution.
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Contaminación del Aire , Exposición a Riesgos Ambientales , Material Particulado , Humanos , Dinamarca/epidemiología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Exposición a Riesgos Ambientales/efectos adversos , Contaminación del Aire/efectos adversos , Material Particulado/efectos adversos , Material Particulado/análisis , Estudios Prospectivos , Infertilidad Masculina/epidemiología , Infertilidad Masculina/etiología , Ruido del Transporte/efectos adversos , Ruido del Transporte/estadística & datos numéricos , Factores de Riesgo , Infertilidad Femenina/epidemiología , Infertilidad Femenina/etiología , Infertilidad/epidemiología , IncidenciaRESUMEN
BACKGROUND: Patients with atrial fibrillation (AF) often have concomitant long-term conditions that negatively impact their quality of life and the clinical management they receive. The AFFIRMO study aimed to identify the needs, quality performance indicators (QPIs), and outcomes relevant to patients, caregivers and healthcare professionals (HCPs) to improve the care of patients with AF. METHODS: An on-line survey to collect the key needs, QPIs, and outcomes relevant to patients with AF, their caregivers and HCPs, was distributed between May 2022 and January 2023 in five countries (UK, Italy, Denmark, Romania and Spain). Results from the on-line survey were discussed in a three-round Delphi process with international representatives of patients with AF, caregivers, and HCPs to determine the key needs, QPIs and outcomes for the management of patients with AF and multimorbidity. RESULTS: 659 patients (47.2% males, mean (SD) age 70.9 (10.2) years), 201 caregivers (26.9% males, mean (SD) age: 58.3 (SD 15.2) years), and 445 HCPs (57.8% males, mean (SD) age 47.4 (10.6) years) participated in the survey. An initial list of 27 needs, 9 QPIs, and 17 outcomes were identified. Eight patients, two caregivers, and 11 HCPs participated in the Delphi process. Nineteen (70%) needs, 8 (89%) QPIs, and 13 (76%) outcomes reached "consensus in", and were included in the final list. CONCLUSIONS: The final key needs, QPIs and outcomes obtained from the Delphi process will inform the AFFIRMO clinical trial, which aims to test the iABC app which incorporates an empowerment toolbox for patients and their caregivers, providing information to improve patient engagement and empowerment to help improve the clinical and self-management of patients with AF in the context of multimorbidity.
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Fibrilación Atrial , Multimorbilidad , Indicadores de Calidad de la Atención de Salud , Humanos , Fibrilación Atrial/terapia , Fibrilación Atrial/epidemiología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Calidad de Vida , Encuestas y Cuestionarios , Cuidadores , Técnica Delphi , Adulto , Dinamarca/epidemiología , España/epidemiología , Personal de Salud/psicología , Italia/epidemiología , Rumanía/epidemiología , Anciano de 80 o más AñosRESUMEN
BACKGROUND: The congenital heart disease (CHD) population is growing and aging. We aim to examine the impact by describing the temporal trend and causes of lifetime hospitalization burden among the CHD population. METHODS AND RESULTS: From the Danish National Patient Registry, 23 141 patients with CHD and their hospitalizations from 1977 to 2018 were identified, excluding patients with extracardiac malformation. Patients with CHD were categorized into major CHD and minor CHD, and each patient was matched with 10 controls by sex and year of birth. The rate of all-cause hospitalization increased over time from 28.3 to 36.4 hospitalizations per 100 person-years (PY) with rate difference (RD) per decade of 2.5 (95% CI, 2.0-3.1) hospitalizations per 100 PY for the patients with CHD, compared with the increase from 10.8 to 17.0 per 100 PY (RD per decade, 2.0 [95% CI, 1.8-2.2] per 100 PY) for the control group (RD for CHD versus control, P=0.08). The all-cause hospitalization rate remained constant for the major CHDs (RD per decade, -0.2 [95% CI, -1.2 to 0.9] per 100 PY) but increased for the minor CHDs (RD per decade, 5.2 [95% CI, 4.3-6.0] per 100 PY). For all patients with CHD, the cardiovascular hospitalization rate remained constant over time (RD per decade, 0.2 [95% CI, -0.3 to 0.6] per 100 PY) whereas the noncardiovascular hospitalization rate increased (RD per decade, 2.1 [95% CI, 1.6-2.7] per 100 PY). The length of all-cause hospital stays for all patients with CHD decreased from 2.7 (95% CI, 2.6-2.8) days per PY in 1977 to 1987 to 1.6 (95% CI, 1.6-1.7) days per PY in 2008 to 2018. CONCLUSIONS: Compared with previous decades, patients with CHD have an increasing hospitalization rate, similar to the general population, but a decreasing length of hospital stay. The increase in hospitalization rate was driven by noncardiovascular hospitalizations, with the patients with minor CHD being the key contributor to the increasing rate.
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Cardiopatías Congénitas , Hospitalización , Sistema de Registros , Humanos , Dinamarca/epidemiología , Cardiopatías Congénitas/epidemiología , Cardiopatías Congénitas/terapia , Femenino , Masculino , Hospitalización/tendencias , Hospitalización/estadística & datos numéricos , Adulto , Persona de Mediana Edad , Factores de Tiempo , Adolescente , Adulto Joven , Niño , Preescolar , Lactante , Recién NacidoRESUMEN
BACKGROUND: Atopic diseases, obesity and neuropsychiatric disorders are lifestyle-related and environmental-related chronic inflammatory disorders, and the incidences have increased in the last years. OBJECTIVE: To outline the design of the 18-year follow-up of the Copenhagen Prospective Study on Asthma in Childhood (COPSAC2000) birth cohort, where risk factors of atopic diseases, obesity and neuropsychiatric disorders are identified through extensive characterisation of the environment, along with deep clinical phenotyping and biosampling for omics profiling. METHODS: COPSAC2000 is a Danish prospective clinical birth cohort study of 411 children born to mothers with asthma who were enrolled at 1 month of age and closely followed at the COPSAC clinical research unit through childhood for the development of atopic diseases. At the 18-year follow-up visit, biomaterial (hair, blood, urine, faeces, throat, and skin swabs, nasal lining fluid and scraping, and hypopharyngeal aspirates) and extensive information on environmental exposures and risk behaviours were collected along with deep metabolic characterisation and multiorgan investigations including anthropometrics, heart, lungs, kidneys, intestines, bones, muscles and skin. Neuropsychiatric diagnoses were captured from medical records and registers accompanied by electronic questionnaires on behavioural traits and psychopathology. RESULTS: A total of 370 (90%) of the 411 cohort participants completed the 18-year visit. Of these, 25.1% had asthma, 23.4% had a body mass index >25 kg/m2 and 16.8% had a psychiatric diagnosis in childhood. Of the 62 probands with a neuropsychiatric diagnosis in childhood, a total of 68.7% drank alcohol monthly, and when drinking, 22.2% drank >10 units. Of the participants, 31.4% were currently smoking, and of these, 24.1% smoked daily. A total of 23.8% had tried taking drugs, and 19.7% reported having done self-destructive behaviour. The mean screen time per day was 6.0 hours. CONCLUSION: This huge dataset on health and habits, exposures, metabolism, multiorgan assessments and biosamples from COPSAC2000 by age 18 provides a unique opportunity to explore risk factors and underlying mechanisms of atopic disease and other lifestyle-related, non-communicable diseases such as obesity and neuropsychiatric disorders, which are highly prevalent in the community and our cohort.
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Asma , Cohorte de Nacimiento , Humanos , Dinamarca/epidemiología , Femenino , Masculino , Asma/epidemiología , Estudios de Seguimiento , Adolescente , Estudios Prospectivos , Factores de Riesgo , Niño , Trastornos Mentales/epidemiología , Preescolar , Lactante , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Proyectos de InvestigaciónRESUMEN
PURPOSE: This 13-year consecutive case series aims to provide a comprehensive overview of all patients operated for clival chordomas and clival chondrosarcomas in Denmark since the centralization of treatment in 2010, comparing outcomes to international series. METHODS: This was a retrospective review of 33 patients with clival tumors, comprising 22 chordomas and 11 chondrosarcomas, who were treated at Copenhagen University Hospital between years 2010 and 2023. Data were collected from digital patient records and pathology reports. RESULTS: The symptoms leading to diagnosis primarily included double vision, headaches, and dizziness. In general, patients were in good health, with a mean Charlson Comorbidity Index score of 1.6. The complication rate of the index surgery was 51.5%. Adjuvant radiotherapy was applied in 51.5% of the cases. In patients with clival chordomas, the mean age was 51.1 years, ranging from 16 to 83 years. At the time of diagnosis, the mean tumor volume was 20.9 cm3 and the five-year overall survival rates were 79.1% (95% confidence interval (CI): 62.4-100). In patients with chondrosarcomas, the mean age was 48.2 years, ranging from 15 to 76 years. At the time of diagnosis, the mean tumor volume was 22.3 cm3 and the five-year overall survival 90% (95% CI: 73.2-100). CONCLUSION: The centralized treatment of clival tumors in Denmark demonstrates incidence, survival, and complication rates comparable to those found in other international series. Given the variations in treatment strategies, tumor localizations across series, and small sample sizes, the further analysis of larger compiled multicenter datasets for clival tumors could provide more solid evidence regarding the management of these rare tumors.
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Condrosarcoma , Cordoma , Fosa Craneal Posterior , Neoplasias de la Base del Cráneo , Humanos , Persona de Mediana Edad , Adulto , Masculino , Femenino , Neoplasias de la Base del Cráneo/patología , Neoplasias de la Base del Cráneo/cirugía , Anciano , Condrosarcoma/cirugía , Condrosarcoma/patología , Dinamarca/epidemiología , Adulto Joven , Estudios Retrospectivos , Adolescente , Cordoma/cirugía , Cordoma/patología , Cordoma/radioterapia , Fosa Craneal Posterior/patología , Fosa Craneal Posterior/cirugía , Anciano de 80 o más Años , Resultado del TratamientoRESUMEN
Monozygotic twins share the same genotype; however, they can be phenotypically discordant on various traits. Studying discordant monozygotic twins allows the investigation of differences in associations between symptoms and psychopathological risk factors, controlled for shared genetic liability. The network approach to psychopathology suggests that depressive symptoms, along with risk and protective factors (e.g., cognition, daily activities), form a complex system of mutually interacting components. We compared monozygotic twins discordant for lifetime depression on their respective extended networks of depressive symptoms, cognitive functions and daily activities (intellectual, physical, social), and evaluated if these networks differ in their associations between variables and in the role of each variable within the network. Regularized partial correlations investigated the networks' composition in 147 monozygotic twin pairs discordant for depression from the Danish Twin Registry. Affected twins had stronger overall associations within their network of depressive symptoms, cognitive functions and daily activities than their unaffected co-twins, while the importance of the network components' associations did not differ between the co-twins. In affected twins, decreased frequency in experiencing happiness had the strongest association with remaining variables (i.e., the most influence in activating other network elements). Also, variables from different groups were significantly associated (e.g., loneliness with delayed memory, pessimism with low social activities, verbal learning with intellectual activities). In unaffected twins, both mood symptoms and cognitive functions were important, but between-groups associations were quasi-absent. These results suggest that external events affecting the ability to feel happiness likely trigger the psychopathological process (depression network activation), independently from the genetic predisposition to depression.
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Actividades Cotidianas , Depresión , Sistema de Registros , Gemelos Monocigóticos , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Depresión/fisiopatología , Depresión/genética , Dinamarca/epidemiología , Enfermedades en Gemelos/genética , Cognición/fisiología , AncianoRESUMEN
BACKGROUND: Increasing severity of chronic obstructive pulmonary disease (COPD) is associated with increasing risk of poor outcomes. Using health registry data, we aimed to assess the association between treatment intensity levels (TIL), as a proxy for underlying COPD severity, and long-term outcomes. METHODS: Using Danish nationwide registries, we identified patients diagnosed with COPD during 2001-2016, who were alive at index date of 1 January 2017. We stratified patients into exclusive TILs from least to most severe: no use, short term therapy, mono-, dual-, triple therapy, oral corticosteroid (OCS), and long-term oxygen treatment (LTOT). Survival analyses were used to assess 5-year outcomes by TIL. RESULTS: We identified 53,803 patients with COPD in the study period (median age: 72 years [inter quartile range, 64-80], 48 % male). The three most severe TILs were associated with a significant incremental increase in all-cause mortality with an adjusted hazard ratio (aHR) for triple therapy, OCS and LTOT of 1.44 (95 % CI: 1.38-1.51), 1.67 (95 % CI: 1.59-1.75), and 2.91 (95 % CI: 2.76-3.07) compared with those receiving no therapy as reference. The same pattern was evident for the composite outcome of 5-year mortality or COPD-related hospitalization with an aHR for triple therapy, OCS and LTOT of 2.30 (95 % CI: 2.22-2.38), 2.85 (95 % CI: 2.74-2.96), and 4.00 (95 % CI: 3.81-4.20), respectively. CONCLUSION: Increasing TILs were associated with increasing five-year mortality and risk of COPD-related hospitalization. TILs may be used as a proxy for underlying COPD severity in epidemiological studies.
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Enfermedad Pulmonar Obstructiva Crónica , Sistema de Registros , Índice de Severidad de la Enfermedad , Humanos , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Anciano , Masculino , Femenino , Anciano de 80 o más Años , Medición de Riesgo/métodos , Persona de Mediana Edad , Dinamarca/epidemiología , Corticoesteroides/uso terapéutico , Terapia por Inhalación de OxígenoRESUMEN
BackgroundIn 2022, a global monkeypox virus (MPXV) clade II epidemic occurred mainly among men who have sex with men. Until early 1980s, European smallpox vaccination programmes were part of worldwide smallpox eradication efforts. Having received smallpox vaccine > 20 years ago may provide some cross-protection against MPXV.AimTo assess the effectiveness of historical smallpox vaccination against laboratory-confirmed mpox in 2022 in Europe.MethodsEuropean countries with sufficient data on case vaccination status and historical smallpox vaccination coverage were included. We selected mpox cases born in these countries during the height of the national smallpox vaccination campaigns (latest 1971), male, with date of onset before 1 August 2022. We estimated vaccine effectiveness (VE) and corresponding 95% CI for each country using logistic regression as per the Farrington screening method. We calculated a pooled estimate using a random effects model.ResultsIn Denmark, France, the Netherlands and Spain, historical smallpox vaccination coverage was high (80-90%) until the end of the 1960s. VE estimates varied widely (40-80%, I2 = 82%), possibly reflecting different booster strategies. The pooled VE estimate was 70% (95% CI: 23-89%).ConclusionOur findings suggest residual cross-protection by historical smallpox vaccination against mpox caused by MPXV clade II in men with high uncertainty and heterogeneity. Individuals at high-risk of exposure should be offered mpox vaccination, following national recommendations, regardless of prior smallpox vaccine history, until further evidence becomes available. There is an urgent need to conduct similar studies in sub-Saharan countries currently affected by the MPXV clade I outbreak.
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Vacuna contra Viruela , Vacunación , Humanos , Masculino , Vacuna contra Viruela/historia , Vacunación/estadística & datos numéricos , Vacunación/historia , Europa (Continente)/epidemiología , Mpox/prevención & control , Mpox/historia , Mpox/epidemiología , Viruela/prevención & control , Viruela/historia , Viruela/epidemiología , Francia/epidemiología , España/epidemiología , Países Bajos/epidemiología , Eficacia de las Vacunas , Adulto , Homosexualidad Masculina/estadística & datos numéricos , Dinamarca/epidemiología , Programas de Inmunización/historia , Cobertura de Vacunación/estadística & datos numéricosRESUMEN
BACKGROUND: Cardiovascular diseases (CVDs) are major causes of mortality and morbidity worldwide; yet the understanding of their molecular basis is incomplete. Multi-omics studies have significant potential to uncover these mechanisms, but such studies are challenged by genetic and environmental confounding-a problem that can be effectively reduced by investigating intrapair differences in twins. Here, we linked data on all diagnoses of the circulatory system from the nationwide Danish Patient Registry (spanning 1977-2022) to a study population of 835 twins holding genome-wide DNA methylation and gene expression data. CVD diagnoses were divided into prevalent or incident cases (i.e., occurring before or after blood sample collection (2007-2011)). The diagnoses were classified into four groups: cerebrovascular diseases, coronary artery disease (CAD), arterial and other cardiovascular diseases (AOCDs), and diseases of the veins and lymphatic system. Statistical analyses were performed by linear (prevalent cases) or cox (incident cases) regression analyses at both the individual-level and twin pair-level. Significant genes (p < 0.05) in both types of biological data and at both levels were inspected by bioinformatic analyses, including gene set enrichment analysis and interaction network analysis. RESULTS: In general, more genes were found for prevalent than for incident cases, and bioinformatic analyses primarily found pathways of the immune system, signal transduction and diseases for prevalent cases, and pathways of cell-cell communication, metabolisms of proteins and RNA, gene expression, and chromatin organization groups for incident cases. This potentially reflects biology related to response to CVD (prevalent cases) and mechanisms related to regulation and development of disease (incident cases). Of specific genes, Myosin 1E was found to be central for CAD, and DEAD-Box Helicase 5 for AOCD. These genes were observed in both the prevalent and the incident analyses, potentially reflecting that their DNA methylation and gene transcription levels change both because of disease (prevalent cases) and prior disease (incident cases). CONCLUSION: We present novel biomarkers for CVD by performing multi-omics analysis in twins, hereby lowering the confounding due to shared genetics and early life environment-a study design that is surprisingly rare in the field of CVD, and where additional studies are highly needed.
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Enfermedades Cardiovasculares , Metilación de ADN , Humanos , Metilación de ADN/genética , Dinamarca/epidemiología , Enfermedades Cardiovasculares/genética , Enfermedades Cardiovasculares/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Anciano , Sistema de Registros , Epigénesis Genética/genética , Estudio de Asociación del Genoma Completo/métodos , Adulto , MultiómicaRESUMEN
PURPOSE: Breast cancer has an average 10-year relative survival reaching 84%. This favorable survival is due, in part, to the introduction of biomarker-guided therapies. We estimated the population-level effect of the introduction of two adjuvant therapies-tamoxifen and trastuzumab-on recurrence using the trend-in-trend pharmacoepidemiologic study design. METHODS: We ascertained data on women diagnosed with nonmetastatic breast cancer who were registered in the Danish Breast Cancer Group clinical database. We used the trend-in-trend design to estimate the population-level effect of the introduction of (1) tamoxifen for postmenopausal women with estrogen receptor (ER)-positive breast cancer in 1982, (2) tamoxifen for premenopausal women diagnosed with ER-positive breast cancer in 1999, and (3) trastuzumab for women <60 years diagnosed with human epidermal growth factor receptor 2-positive breast cancer in 2007. RESULTS: For the population-level effect of the introduction of tamoxifen among premenopausal women diagnosed with ER-positive breast cancer in 1999, the risk of recurrence decreased by nearly one-half (OR = 0.52), consistent with evidence from clinical trials; however, the estimate was imprecise (95% confidence interval [CI] = 0.25, 1.85). We observed an imprecise association between tamoxifen use and recurrence from the time it was introduced in 1982 (OR = 1.24 95% CI = 0.46, 5.11), inconsistent with prior knowledge from clinical trials. For the introduction of trastuzumab in 2007, the estimate was also consistent with trial evidence, though imprecise (OR = 0.51; 95% CI = 0.21, 22.4). CONCLUSIONS: We demonstrated how novel pharmacoepidemiologic analytic designs can be used to evaluate the routine clinical care and effectiveness of therapeutic advancements in a population-based setting while considering some limitations of the approach.
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Neoplasias de la Mama , Recurrencia Local de Neoplasia , Tamoxifeno , Trastuzumab , Humanos , Neoplasias de la Mama/tratamiento farmacológico , Femenino , Tamoxifeno/uso terapéutico , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Trastuzumab/uso terapéutico , Quimioterapia Adyuvante , Adulto , Receptores de Estrógenos , Dinamarca/epidemiología , Farmacoepidemiología , Anciano , Antineoplásicos Hormonales/uso terapéutico , Premenopausia , Receptor ErbB-2 , PosmenopausiaRESUMEN
OBJECTIVES: The aim was to examine exposure-response relations between occupational hand exposures and carpal tunnel syndrome (CTS) and to compare the relation between surgery-treated and non-surgery-treated CTS. The secondary aim was to study sex-specific differences in exposure-response relations. METHODS: We conducted a nationwide register-based cohort study of all persons born in Denmark (1945-1994). During follow-up (2010-2013), we identified first-time events of CTS. Occupational hand exposure estimates the year before each follow-up year were obtained by linking individual occupational codes with a job exposure matrix. We used multivariable logistic regression equivalent to discrete survival analysis based on sex and surgery. The excess fraction of cases was calculated. RESULTS: For both sexes, exposure-response relations were found for all occupational hand exposures. Among men, we found ORadj of 3.6 (95% CI 3.2 to 3.8) for hand-related force, 2.9 (95% CI 2.5 to 3.2) for repetitive hand movements, 3.8 (95% CI 2.7 to 5.2) for non-neutral hand posture and 2.5 (95% CI 2.2 to 2.7) for hand-arm vibration in the highest exposure groups. For combined exposure (hand load), ORadj was 3.5 (95% CI 3.1 to 4.0). Slightly higher ORsadj were generally found for surgery-treated CTS compared with non-surgery-treated CTS for both sexes. When comparing sex, somewhat higher ORsadj were found among men. The excess fraction was 42%. CONCLUSIONS: Occupational hand exposures carried a 3-5-fold increased risk of CTS with slightly higher risks for surgery-treated compared with non-surgery-treated CTS. Even though CTS occurs more frequently among women, somewhat higher exposure-response relations were found for men compared with women. In the general working population, a substantial fraction of first-time CTS could be related to occupational hand exposures.